Low diastolic = 911?

Posted

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Been there,done that, ASN, RN

Has 33 years experience. 6,854 Posts

Why is a new grad placed in a supervisory position?

Why did the staff nurse quit?

Why was there not floor coverage available?

How was YOUR documentation "fixed"?

Why are you held accountable for this and why did management have time to revew your charting, yet not be available for assistance.

Why are you hanging your new, hard- won license out in the wind???:idea:

ImThatGuy, BSN, RN

2,139 Posts

Why is a new grad placed in a supervisory position?

Why did the staff nurse quit?

Why was there not floor coverage available?

How was YOUR documentation "fixed"?

Why are you held accountable for this and why did management have time to revew your charting, yet not be available for assistance.

Why are you hanging your new, hard- won license out in the wind???:idea:

Heck, around here it's nothing for a new grad RN, particularly a BSN, to land an ADON job in a nursing home. Nobody likes LTC in Arkansas it seems.

love-d-OR

love-d-OR

Specializes in Transplant/Surgical ICU. Has 3 years experience. 542 Posts

There are dangers associated with low/absent diastolic blood pressure! Go back to the heart pump/blood pressure cycles. What is diastole? First issue that comes to mind is cardiac tamponade; symptoms include widening pulse pressure, if you don't have a diastolic pressure, then how can you assess this? Also, remember that the mean arterial pressure is the standard for determining adequate organ perfusion, if you do not have a diastolic pressure how can you determine a mean pressure?

Nursing home patients are not your regular grandma and gradpa that need some TLC anymore, these guys are sick. I see them come into the ICU and I wonder how you all care for them and 20 more patients. DO NOT put your license in jeopardy. CYA, CYA,CYA,CYA, CYA.............CYA! If it comes down to it, next time chart you were not able to get a pressure, BUT you did a full assessment on the patient they were at baseline, asymptomatic, yada yada yada, and then say you will try in like 30mins. But don't let grandma/grandpa have no BP charted for the day. You are not an EMS personnel anymore, you are an RN. You have more to loose and more to pay. Hope you are looking for work some place else...

Edited by love-d-OR

KaitRN

KaitRN

Specializes in LTC, New to Tele/ Cardiac!. 52 Posts

I work on a cardiac unit where BP's are all over the place. And it's true, especially in the geriatric population it can be very difficult to hear diastolic. We never have an issue when alerting the MD to a low or irregular BP and stating just the systolic, diastolic unable to hear. If you go very slow sometimes you are able to get a reading but if you can't I think at least verifying an SBP is better than nothing!! I may be wrong but I believe that sometimes you cannot hear the diastolic due to low perfusion? I think you did a very smart thing by documenting it that way. It does concern me that the ADON "fixed" your charting, but I also started out in LTC as a new grad and I totally understand how it works there. There's a lot of "fixing" that happens which is scary hence why I left as soon as I could land a hospital job! Good luck to you and I would support your documentation fully.

aglpn

aglpn

Specializes in Dermatology, Pain Management, LTC. Has 3 years experience. 3 Posts

but I also started out in LTC as a new grad and I totally understand how it works there. There's a lot of "fixing" that happens which is scary hence why I left as soon as I could land a hospital job! Good luck to you and I would support your documentation fully.

um that's NOT "how it works there." i worked at a nursing home as a new grad (first job - right out of school). i reported EIGHT nurses/cna's (one was an rn that was doing meth) for smoking weed on breaks and then doing patient care, for stealing narcotics, and other things. they all got fired or "quit" because they refused to do the random drug test. it's YOUR responsibility to report something that is unethical or else you're practically doing it, too. it's not right, and thats why so many ltc facilites are messed up and families don't know what's going on while their loved one lay in their soiled clothing because some idiots decided to do drugs on the job instead. it's very important you report because it will be your license on the line!

mandykal, ADN, RN

Has 16 years experience. 343 Posts

I carrier around my little portable cuff just in case I can't hear DBP. I also have the pt take a little walk to the BR and assess after activity then recheck later. Another thing about LTC, most Companies have CNA's take vital signs perhaps asking a peer to check it. Recheck your method. Sometimes placement of the diaphagm, and how slow you release the pressure makes a whole difference.

In addition to the previous posters, I would question and follow up on unethical practices....was your note edited with a false information?

NotFlo

NotFlo

348 Posts

How can they have you supervising without training you to work the floor?

Woodenpug

Woodenpug, BSN

Specializes in MPCU. 734 Posts

A couple thoughts here. The Korotkoff sounds, change at the diastolic point. They may not, always, become inaudible. A systolic of X over palpation, means exactly that, you could not hear proper sounds and so had to use palpation. The diastolic measure is meaningless if you use palpation. The same is true of Doppler. One would correctly only give the sbp over doppler, because one is not really able to determine dbp. Sorry, changed to 'one' from 'you' to appear less accusatory, and succeeded only in sounding more pompous.

Second thought. You only need to cya if you fail to care for your patient, or are in a closed shop. If you do not care for your patient, I would hope that your patient's well being is more important than YA.

tainted1972

tainted1972, ASN, RN

Specializes in MR/DD. Has 3 years experience. 271 Posts

Was there a doppler available? Personally I would have taken the BP with the doppler and charted it 120/doppler

the fact the your DON "fixed" your documentation is scary.. have you looked at it?

Did she forge anything? Lie?

I have seen nurses add to documentation to further explain things to "fix" it which is fine, as long as it is truthful. :)

BCRNA

BCRNA

255 Posts

There is no such thing as an emergency due to low diastolic pressure. Low diastole can meen the patient is dehydrated. Systole is the highest pressure in the vascular system with the heart pumping, diastole is at complete rest. If the diastolic pressure was around 20 to 30 or so, it would be very difficult to say exactly what it was. In no circumstances is this an emergency, as long as you completely assessed the patient and there were no signs of acute distress.

There is nothing wrong with charting just a systolic pressure and not a diastolic as long as a complete assessment was done and charted. Mean pressure is a great indicator of organ perfusion, but not the only one. If cardiac tamponade was causing this, there would be other very clear indicators of distress. My personal experience is that cardiac tamponade would not have adequate perfusion; that is the systolic would be low also with signs of decreased peripheral perfusion. Absent of any other clinical signs of distress a physician would laugh at you for providing a call for a low diastolic with a more than adequate systolic. I have done anesthesia in trauma cases for almost ten years, and not once have I seen anyone panic over a low diastolic pressure. When a trauma or vascular surgeon asks for a blood pressure, often I just give the systolic value.

love-d-OR

love-d-OR

Specializes in Transplant/Surgical ICU. Has 3 years experience. 542 Posts

Bryan,

Agreed that it is not worth calling 911, but it is important to: be aware that the absence of a DBP is not just something to ignore because you have a SBP. I used those extreme examples to make a point, not to say that tha's what was going on with the patient. Dehydration as you stated is not something to ignore either. I assume by your username that you are an advance practice nurse, so you have the scope of practice and knowledge to manage this on your own and adequately. But for a nurse in a nursing home all by herself, she needs to be aware of suttle things like this. Again, I'm not advocating call 911...but be aware of things, do an assessment and chart accordingly. Cardiac tamponade will present with other syptoms true, but again that was just an example to send a message that although frequently overlooked, diastole is an important parameter.

hrluke661987

hrluke661987

1 Post

Exactly. How exactly did she fix it? Did she make up a dialstolic and falsify documentation?